preventing excessive interventions in the normal birth process.

~ Marsden Wagner, MD 1988 World Health Organization

The effort to abolish independent midwives in the United States began in earnest in the late 1800s and reached a fever pitch in the 1900s. One reason midwives needed to be eliminated was to provide more �teaching material� (poor people, usually women and children) for training physicians.

One of the ways to get rid of midwives is to legislate a definition implicating midwifery as �the practice of medicine.� The Board of Medical Examiners tried this a dozen or so years ago in North Dakota. I was getting copies of the Board of Medical Examiner meeting minutes regularly back then, otherwise I would never have been alerted to this. Request the meeting minutes of your state�s medical board. A Directory of State Medical Boards is available at www.fsmb.org/directory_smb.html and by contacting the Federation of State Medical Boards, PO Box 619850, Dallas, Texas 75261-9850 Phone: (817) 868-4000 FAX: (817) 868-4099.

Another way to get rid of independent midwifery is to place regulated midwives in medical service and prohibit them from attending out-of-hospital births. Make sure they are grateful to be able to serve as a midwife in any capacity. In North Dakota a provision for a Certified Nurse Midwife license is that they not attend homebirths. (And give them extra points if they publicly malign non-nurse midwives especially in print media.) Autonomy and independence is the trade-off for third-party payment. There is no free cheese in a mousetrap. Credentialed midwifery can be gradually abolished through increasingly strict regulation.

Another way to eliminate the competition of independent midwifery is through restraint of trade. I would love it if midwives were independently wealthy (a few are). To prohibit midwives from earning income is monopolistic and a dangerous way to impede competition and � restrain trade.

One of the reasons midwives are so maligned is because the practice of ob

stetrics has historically not been a very distinguished profession. How much skill does it take to be like a "dog sitting before a rathole waiting for the rat to escape."* The superior results of midwifery care (by mere women, many labeled as illiterate, dirty, gin-guzzling, arrogant, rouge and superstitious old women) was difficult for highly educated �scientific� physicians to accept. Elimination of the midwife would solve the problem.

However, not all physicians were silent about the exceptional services provided by midwives.

The last page of Dr. A. J. Rongy�s 1937 book Childbirth Yesterday and Today: A Story of Childbirth Through the Ages To the Present contains this advice. "If maternal mortality and morbidity is to be reduced at all, a change must be made in the practice of obstetrics. Meddlesome obstetrics costing the lives of many women must be eliminated. A method, a practice must be established, whereby it would be impossible for any obstetrician to "rush" his case. Artificial delivery, whether simple or complicated, should not be attempted..." And Dr. Rongy goes on to say: "But these and similar reforms can come about only as a result of pressure from the women of this country."

And... "Regretfully, women do not seem to realize that men will never solve their problems for them; that is essentially a problem that should and must be solved by the women. They must concern themselves with the fundamental questions relating to maternal mortality; whether improvements can be obtained through government or private agencies; whether maternity centers, catering to and providing for all classes of society must be provided; whether steps should be taken to remove the haphazard methods of obstetrical services."

I would like to see "The Midwife Problem" solved by having more midwives, different kinds of independent

as well as regulated and rogue midwives, meeting the needs of families in their respective communities.

The test for excellence of physician as well as midwifery care is lactation success � The Gold Standard for Maternal and Child Health. How many years did the mothers in their care nurse their children?

* 1911 ~The Midwife Problem and Medical Education in the US Williams, J. M.D.

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